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Organization
HATTIESBURG CLINIC PA
Active
Organization
HATTIESBURG CLINIC PA
Active
Other names
OWL DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE ASHLEY RPH (PHCY DIR)
(601) 268-2740
Entity
Organization
Contact information
Practice address
MEDICAL BLVD, STE 2, HATTIESBURG, MS 39401
(601) 268-5740
(601) 268-5858
Mailing address
MEDICAL BLVD, STE 2, HATTIESBURG, MS 39401
(601) 268-5740
(601) 268-5858
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
01821/1.1
MS
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030291
—
MS
01
—
2045095
PK
—
Enumeration date
07/30/2006
Last updated
02/21/2017
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